29-159 (3) 83 BRIERWOOD DR BP-2017-1151
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 29- 159 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: INSULATION BUILDING PERMIT
Permit# BP-2017-1151
Project# JS-2017-001951
Est.Cost: $3115.00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: AMERICAN INSTALLATIONS LLC 106178
Lot Siee(sq. ft.): 10018.80 Owner: DURANT MARIE L
Zonz� Applicant: AMERICAN INSTALLATIONS LLC
AT: 83 BRIERWOOD DR
Applicant Address: Phone: Insurance:
130 COLLEGE ST (413) 552-0200 WC
SOUTH HADLEYMA01075 ISSUED ON:4/13/2017 0:00:00
TO PERFORM THE FOLLOWING WORK ATTIC AND BASEMENT INSULATION AND AIR
SEALING THROUGHOUT
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
Underground: Service: Meter:
Footings:
Rough: Rough: House# Foundation:
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire Department Fireplace/Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy Signature:
FeeType: Date Paid: Amount:
Building 4/13/2017 0:00:00 565.00
212 Main Street, Phone(413)587-1240. Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
File# BP-2017-1151
APPLICANT/CONTACT PERSON AMERICAN INSTALLATIONS LLC
ADDRESS/PHONE 130 COLLEGE ST SOUTH HADLEY (413)552-0200
PROPERTY LOCATION 83 BRIERWOOD DR
MAP 29 PARCEL 159 001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid G 1 ICI•
Building Permit Filled out IVA.,
Fee Paid
Typeof Construction: ATTIC AND BASEMENT INSULATION AND AIR SEALING THROUGHOUT
New Constmction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 106178
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INiktRMATION PRESENTED:
pproved Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan AND/OR Special Permit With Site Plan
Major Project:_ Site Plan AND/OR Special Permit With Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: §
Finding Special Permit Variance*
Received& Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street Commission Permit DPW Storm Water Management
D- +lition ala
y�3 V?
Si: of Building Official Date
Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
requirements and obtain all required permits from Board of Health,Conservation Commission,Department
of public works and other applicable permit granting authorities.
* Variances are granted only to those applicants who meet the strict standards of MGL 40A.Contact Office of
Planning&Development for more information.
/^ 17-0808
•
'Department use Drily
City of Northampton Status of Permit
, Z r-,
'1 r-, Building Department Curb�cutlDdveway pelma
C QQ� _ 212 Main Street SewerlsepacAvailabnity .
Room 100 Waters ell Availability
-
.
�r _ Northampton, MA 01060 Two Seta of9bucturecP,lans
phone 413-587-1240 Fax 413-587-1272 PlouSite Plane ,
Otter Spedfy
APPLICATION TO CONSTRUCT,ALTER,REPAIR RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELUNG
SECTION 1 -SITE INFORMATION
1.1 Property Address: This section to be comp) d by office
83 Brierwood Drive Map d q Lot Una.
Florence,MA 01062 Zone Overlay District
Elm St District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Marie Durant&David Nanartonis 83 Brierwood Drive Florence, MA 01062
Name(Print) Covent Mailing Address:
(413)586-0295
See attached - Telephone
Signature
2.2 Authorized Mont
American Installations 130 College St., Ste 100 South Hadley, MA 01075
Name(PdM) Current Mating Address:
American Installations 413-552-0200
Signature Telephone
SECTION S-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building $3,115.60 (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from(6)
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5.Fire Protection
40 6. Total=(1 +2+3+4+5) $3,115.60 Check Number itA5- / 6—
This Section For Official Use Only
Building Permit Number: Is u
Dated:
Signature:
Building Commisslonedlnspector of Buildings Date
,
Section 4. ZONING AU Information Must Be Completed.Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This column to be filled in by
Buildwg Deparboeat
Lot Size I 1 I
Frontage (—_-_-
Setbacks Front I
Side L: I R4 L:I I R: I 1---I
Rear Ii I F--1
Building Height I ( I
Bldg.Square Footage % L I I
Open Space Footage % 'I
(tot arca minas bMg&paved I I I I i J
perking)
if of Parking Spaces I-i I _i
Fill: - - _ K
(volume&ionadm) —_-__-- __—Ii---_____ II
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO Q DONT KNOW 0 YES 0
IF YES, date issued:I 1
IF YES: Was the permit recorded at the Registry of Deeds?
NO Q DONT KNOW Q YES Q
IF YES: enter Book I I Page I and/or Document PI
B. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW Q YES Q
IF YES,has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Q Obtained Q , Date Issued: '
C. Do any signs exist on the property? YES Q NO Q
IF YES,describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES O NO Q
IF YES,describe size, type and location:
E. Will the construction activity disturb(baring,gradingOcavation,melting)over I acre or Is it part of a common plan
that will dMurb over l acre? YES NO
IF YES,then a Northampton Storm Water Management Penni from the DPW is required.
SECTION 6-DESCRIPTION OF PROPOSED WORK(Check all applfeeble)
New House 0 Addition 0 Replacement Windows Alteration(s) [J Roofing
Or Doors 0
Accessory Bldg. D Demolition 0 New Signs [C11 Decks [q Siding gJ) Other*
Brief Descit ar of ropnsed
r/leer Attic and basement insulation and air sealing throughout
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
se.If New house and pr addition to existinghousing,complete the following;
a. Use of building:One Family Two Family Other
b. Number of rooms N each family unit Number of Bathrooms
c. Is there a garage attached?
O. Proposed Square footage of new construction. Dimensions
e. Number of stories?
I. Method of heating? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Messchecc Energy Compaarce form attached?
h. Type of construction
I. Is construction within 100 ft of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No
j. Depth of beaconing or cellar floor below finished grade
k. Will building conform to the Building and Zoning regulations? Yes No.
I. Septic Tank City Sewer Private well City water Supply_,__
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERM
Marie Durant ea David Nanartonis as Omer ofthe std*ject
proparty
hereby authorize American Installations
to act on my behalf,in all matters relative to work authorized by this building permit application.
See attached 4/12/17
Sig nature of Owner Date
I, American Installations as Owner/Authorized
Agent hereby decare that the ebtamLots and Information on the foregoing application are hue and accurate,to the bast of my knowledge
and belief.
Signed under the pains and penalties of perjury.
American Installations
Print Name
American Installations 4/12/17
Signature of Owner/Agent Date
•
SECTION 6-CONSTRUCTION SERVICES
6.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Roder: Wesley K. Couture 106178
License Number
130 College St., Ste 100 South Hadley,MA 01075 9/29117
EXplmaan Dna
(..,01-17-423-552-0200na Telephone
9,Registered Rothe Improvement Contractor. _ Not Applicable 0
Wesley Couture 175982
Company Name Registration Number
American Installations 6/27/17
Address Expiration Date
130 College St., Ste 100 South Hadley, MA 01075 Telephone 413-552-0200
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application.Failure to provide this affidavit will result
in the denial of the issuance of the budding permit.
Signed Affidavit Attached Yes 01 No ❑
11.-Home Owner.Exemption
The current exemption for"homeowners"was extended to include Owner-occupied Dwetines of one(I) or two(2)families
and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owner acts
as supervisor.CMR 780, Sixth Edition Section 1083.5.1.
Definition of Homeowner:Person(s)who own a parcel of land on which he/she resides or intends to reside,on which there
is,or is intended to be,a one or two family dwelling,attached or detached structures accessory to such use and/or farm
structures. Derma who constructs more than one home in a two-year period shall not be considered a homeowner.
Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official that he/she shall bi
responsible for MI such work performed under the bpildbm permit.
As acting Construction Supervisor your presence on the job site will be required from time to time,during and upon
completion of the work for which this permit is issued
Also be advised that with reference to Chapter 132(Workers'Compensation) and Chapter 153(Liability of Employers to
Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,you may be liable for person(s)
you hire to performwork for you under this permit
The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of
Northampton Ordinances,State and Local Zoning Laws and State ofMassachuseDs General Laws Annotated.
Homeowner Signature
• City of Northampton
•{ b. Massachusetts
ADING
aanS re . tarnici al Building x..
212 Main Strath. • Hvvici 1 evildin Ca
sem..( ✓ Y 9
.�___... Horthamptov, NT 91089 eo
Property Address; 83 Brierwood Drive Florence,MA 01062
Contractor
Name: American Installations
Address: 130 College Street Ste. 100
City, State: South Hadley, MA
Phone: 43-552-0200
Property Owner
Name: Marie Durant&David Nanartonis
Address: 83 Brierwood Drive
City, State: Florence,MA 01062
I, American Installations (contractor)attest and affirm that the building I intend to
insulate does not have any open air(knob and tube)wiring in the spaces to be insulated and that I have
provided the property owner with a copy of this affidavit.
Contragtopsgnat eei // ci�
Date ��((II�� �� f\
4112/17
City of Northampton 212 Main Street,Northampton,MA 01060
Solid Waste Disposal Affidavit
In accordance of the provisions of MGL c 40, S54, I acknowledge that as
a condition of the building permit all debris resulting from the construction
activity governed by this Building Permit shall be disposed of in a properly
licensed solid waste disposal facility, as defined by MGL c 111, S 150A.
Address of the work: 83 Brierwood Drive
The debris will be transported by: American Installations
The debris will be received by: Waste Management - Chicopee Landfill
Building permit number:
Name of Permit Applicant Wesley K. Couture
4-12-17 (AJLAL(�
Date Signature of Permit Applicant
♦ www AmmnanlnstalIt
BBB'.. , { wnocwn
LlcenxeL&Insured
• MA CSL>:106178
American Installations MA Resistrnnon#175982
130 College Street Suite 100,South Hadley,MA 01075•Office;(4131552-0200 Fax:(4131552-0202•Email:wppmt@Ammianlnstallations.cum
Durant,Marie 4/3/2017
839rierwood Drive �a Florence MA 01062
otsksm red isms)413.586.0295 inn
448363 17-0808
Mt Mi quantity Unit Unit Cost 1.10
Total
Air/Duct Sealing
AIR SEALING 8 man hour $ 85.00 $ 68000
DUCT SEALING 1 man hour $ 80.00 $ 8000
WEATHERSTRIP DOOR&ADD SWEEP 2 each $ 80.00 $ 160.00
Air/Duct Sealing $ 920.00
Air/Duct Sealing Incentive $ (920.00)
Air/Duct Selaing WX Balance $ -
Weatherization
CRAWLSPACE WALL RIO RIGID BOARD 71 each $ 405 S 287.55
BASEMENT-INSULATE BULKHEAD DOOR&INSULATE 1 each $ 110.00 $ 110.00
ATTIC HATCH-SEAL&INSULATE 1 each $ 60.00 $ 60.00
VENTILATION CHUTES 80 each $ 2.50 $ 200.00
ATTIC DAMMING-R-38 FIBERGLASS 112 soft $ 2.05 $ 229.60
ATTIC FLAT-8"OPEN R-30 CELLULOSE 880 sgft $ 1.44 $ 1,267.20
REMOVE INSULATION 55 soft $ 0.75 $ 41.25
Total Weatherization $ 2,195.60
Weatherization Incentive $ 1,615.76
Total Project $ 3,115.60
Total Utility Contribution $ 2,535.76
Total Customer Contribution $ 579.84
WARIMICY American Ii stallnonn um mil provided,.above stated aaeowIva with a 2 yea.woa.anslep warrant),.
hereby proposes material and labor to mnniplauee above scope of work accordance with the abovespecifications and ail avl and state buidnd
regulations forth.total Contract Value as stated herein.
The above vias.Spececatdns and TOTAL CONTRACT VALUE= $ 579.84
conditions areOPROPOSAL.satisbctory and are hereby accepted.You
authorized to do work as specified.Payment will be 1/3 down prior to Down Payment= $ 193.00 gl 4-3-2017
start of work,and balance due upon Completion PAID
�(-/l^,5 ., � es) ///�I,Balanace�Duuee Upon Completion= $ 386.84
Durant,Marie /1/✓ivl.(.L) >`�• /gyl4�( 4->- w 4/3/2017
°""'"°""'"'"" cmmS-e.1
Craig A Dragovich '/ 4/3/2017
THIS AGREEMENT ISCOMPOSED OF THIS PAGE AND THE REVERSE SIDE OF THIS PAGE AND SHALL RE CONSIDERED THE ENTIRE AGREEMENT BY THE PARTIES INVOLVED.THIS AGREEMENT IS
BETWEEN AMERICAN INSTALLATIONS,LLC HEREINAFTER REFERRED TO AS"COMPANY",AND THE CUSTOMER(S)NAMED ON THE REVERSE SIDE,HEREINAFTER REFERRED TO AS"CLIENT",AND
WILL BE SU MEET TO ALL APPROPRIATE TAWS,REGULATIONS AND ORDINANCES OF THE STATE OF MASSACHUSETTS OR CONNECTICUT RESPECTIVELY,AS WELL AS ALL LOCAL JURISDICTIONS.
THE FOLLOWING TTRMSAND CONDITIONS ALSO APPLY
1.THIS AGREEMENT IS SUMER TO THE APPROVAL OF A MANAGER OF THE COMPANY FOR THIS AGREEMENT TO BE EFFECTIVE UNDER ANY CONDITION.
2.SHOULD DEFAULT BE MADE IN ME PAYMENT OF THIS AGREEMENT,CHARGES SHALL BE ADDED FROM THE DATE THEREOF AT A RATE OE ONE AND ONE-HALF 11-1/2)PERCENT PER MONTH.
(18%PER ANNUM)WITH A MINIMUM CHARGE OP SEW PER MONTH,AND IF PLACED IN THE HANDS OF AN ATTCIRNEY OR COLLECTION AGENCY FOR COLLECTION,ALL ATTORNEYS FEES,
EXPENSES AND COSTS OF COLLECTION SHALL BE PAW BY THE CUM.IN ADDITION.CLIENT UNDERSTANDS THAT IN FAILING TO PAY ACCOROING TO RIF ABOVE TERMS,COMPANY MAY
HAVE THE MIGHTTOA LEEN ONIHE PROPERTY.
3.THE COMPANY AGREESTHAT WHEN DELAYS BECOME KNOWN TO THE COMPANY,THE COMPANY WILL ADVISETHECLIENT AS SOON AS REASONABLE.
4.COMPANY AGREES THAT, NOTWITHSTANDING ANY AGREEMENT FOR MATERIALS AND/OR LABOR BETWEEN COMPANY AND THIRD PARTY,COMPANY IS RESPONSIBLE TO CLIENT FOR
COMPLETION OF ALL WORK DESCRIBED IN A TIMELY AND WORKMANLIKE MANNER.
5.ALL WARRANTIES FOR EQUIPMENT AND PRODUCTS SUPPLIED BY THE COMPANY UNDER THIS AGREEMENT SHALL BE THOSE GIVEN BY THE MANUFACTURERS OF SUCH EQUIPMENT AND
PRODUCTS.UNDER SUCH MANUFACTURER'S WARRANTIES,THE CLIENT MAY BE REQUIRED TO REGISTER DR MAIL.INA WARRANTY CARD OR OTHER EVIDENCE OF OWNERSWP AND USE OF
SUCHEQUPMEM AND/ORPRODUCTS TN Q40ER TO ACTIVATES/pHWAXRAMIES.
6.TEQIIOTAT'ION ON THE PAGE HEREOF DOES NOT INCLUDE EXPENSES OR CHARGES FOR BOND OR INSURANCE PREMIUMS OR COSTS BEYONDNORMAL INSURANCE COVERAGE,ANY SUCH
ADDITIONAL EXPENSES.PREMIUMS OR CORNWALL BE ADDED TO THE TOTAL AGREEMENT AMOUNT
I.THE COMPANY'S LIABILITY FOR CLAIMS ARISING OUT OF THIS AGREEMENT SHALL NOT EXCEED TTHE TOTAL AGREEMENT PRICE EXCEPT to THE EXTENT THOSE DAMAGES ARE PROVEN TO BE
501EY DUE TO THE COMPANY'S NEGLIGENCE.
8.DURING THE DURATION CF THE WORK,THE CLIENT'S HOMEOWNERS INSURANCE WILL BE RESPONSIBLE FOR ANY AND ALL DAMAGES AS LONG AS TTHE COMPANY HAS TAKEN THE
APPROPRIATE ACTION TO PROTECT AREAS OF WORK.
4 THE COMPANY IS NOT RESPONSIBLE FOR PREEXISTING DEFICIENCIES OR HA AROCUS MATQRIALS THAT MANIFEST 1NEMSRVES DURING THE CONSTRUCTION PROCCESS.E.G.WOOD ROT,
MOLD,ASBESTOS,NAIL POPS,DUCTWORK AND CONNECTIONS,PLUMBING AND VENT PIPES.DECKING DEFLECTION,ETC IF A PREEXISTING DEFICIENCY OR HAZARDOUS MATERIAL IS
ENCOUNTERED PRIOR To OR DURING CONSTRUCTION,AND COMPANY IS NOTIFIED IN W RING,COMPANY WILL TRY DO ASSIST CLIENT WITHIN THE COMPANY'S MEANS AND CAPABIUTIES
TO CORRECT THE PROSLEMIS)ON A TIME AND MATERIAL BASIS CLIENT AGREES THAT SUCH CONDHIONS ARE UNAVOIDABLE BY THE COMPANY AND SHALL NOT BE CONSIDERED A
vIOWPON OF THE AGREEMENT AND THAT DUE TO THESE CONDITIONS THE DURATION OF THE WORK AND scH6OULED DATE OF COMPLETION MAY DIFFER FROM THAT AGREED UPON,IF
APPLICABLE UNDERTHisAGREEMEM,
TTL THE COMPANY IS NOT RESPONSIBLE,AND THE CLIENT AGREES TO HOLD THE COMPANY HARMLESS FOR ANY PROBLEMS AND/OR DAMAGES,ININDTNF",BUT NOT UMITED TO MOLD
GROWTH,ARISING FROM THE PERFORMANCE OF AIASEALING WORK BY THE COMPANY AS A RESULT OF ANY KNOWN OR UNKNOWN MOISTURE CONDITIONS
11.THE COMPANY IS NOT RESPONSIBLE FOR,AND THE CUENT AGREES TO HOLD THE COMPANY HARMLESS.FOR ANY PROBLEMS AND/OR DAMAGES RELATING TO ICE DAMMING THAT MAY
ARISE DURING AND/OR AFTER THE PERFORMANCE OF WORK BYTHE COMPANY.
12.REPLACEMENT OF DETERIORATED DECKING,FASCIA BOARDS ROOF JACKS VENTILATORS FLASHING,RAFTERS,JOISTS,INSULATION OR OTHER MATERIALS ARE NOT INCLUDED UNLESS
OTHERWISE NOTED HEREIN.
13.THE COMPANY WILL NOT BE RESPONSIBLE FOR THE SCRATCHING OR DENTING OF INTERIOR WALES AND CSIUNGS,FLOORS,TRIM,GUTTERS,DOWNSPOUTS,EXISTING SIDING AND
WINDOWS,DOORS,OIL DROPLETS IN DRIVEWAYS,HAIRLINE FRACTURES IN CONCRETE OR BLACKTOP DRIVES AND WALKS,OR DAMAGE TO PLANTS OR SHRUBBERY.IF EXCESSIVE DAMAGE IS
CAUSED BV COMPANY,COMPANY WILL REPAIR OR REPLACE DAMAGED AREA ONLY AT COMPANY'S EXPENSE.
14.THE COMPANY UNDER PROVISIONS OF CHAPTER 142A OF THE GENERAL LAWS IS REQUIRED TO APPLY FOR AND OBTAIN ALL CONSTRUCTION-RELATED PERMITS.THE COMPANY SHALL NOT
BE DEEMED RESPONSIBLE FOR DELAYS IN THE WORK DESCRIBED IN THIS AGREEMENT CAUSED BY REGULATORY PERMIT GRANTING OR INSPECTIONAL AGENCIES.AUTHORITIES,OR
IMANDUALS,
IS THIS AGREEMENT,INCLUDING THE PROVISIONS RELATING TO PRICE AM PAYMENT SCHEDULE CANNOT BE CHANGED OR ALTERED EXCEPT BY A WRITTEN STATEMENT SIGNED BY BOTHTHE
COMPANY AND THE CUENT,
16.ANY REPRESENTATIONS,STATEMENTS,OR OTHER COMMUNICATION NOT WRGTEN ON THIS AGREEMENT ARE AGREED TO BE IMMATERIAL AND NOT RELIED ON BY EITHER PARTY,AND DO
NOTSURVIVE THE EXECUTION OF THIS AGREEMENT.
17.THIS AGREEMENT CANNOT BE CANCELLED W ITHOUT1HE MUTUAL WRITTEN CONSENTOF BOTH PARTIES EXCEPT AS OTHERWISESET FORTH HEREIN.
18.THLSAGREEMENT,ADD ANY WARRANTYIS)PR OV@FpIEREUNDERSHA I.NOT BEASSIGNEDEXCEPT BY OR WITH'REWRITTEN PERMISSION OF SHE COMPANY.
19.IF THE MAW FAILS TO PERFORM ITS OBLIGATIONS HEREUNDER OR TERMINATES THIS AGREEMENT WITHQW THE PRIOR WRRIEN CONSENT Of THE COMPANY,THE°TENT SHAWL RE
LIABLE TOB DAMAGES FOR THE GREATER OF THE COMPANY'S ACTUAL DAMAGES OR 25%OF THEAGREEMENT FOR RESTOCKING FEE.
20.ANY CHANGES TO MATERIALS 0Y'THE CLIENT(BRAND,STYLE.COLOR,ETC I AFTER SAID MATERIAL HAS BEEN DELIVEREDOR IS IN ROUTE TO THE CLIENT MAD RESULT IN A 5%RE-STOCKING
FEE BASED ON THE COST OF SAID MATERIALS.
21.THIS AGREEMENT SHALL BE EFFECTIVE ONLY UPON ITS EXECUTION BY ALL.PARTIES HERETO,PRIOR TO WHICH TIME IT SHALL BE DEEMED A PROPOSAL.THE COMPANY RESERVES THE RIGHT
TO REVOKE THIS PROPOSAL 9O DAYS FROM DATE IT IS EXECUTED BY THE COMPANY IF IT IS NCI EARLIER EXECUTED BY THE CLIENT AND THE REQUIRED DOWN PAYMENT RECEVEO PRIOR TO
THE EX IAANON OF SUCH ID DAY PERIOD;AFTER SD DAYS AND IN THE EVENT COMPANY DOES NOT REVOKE TRE PROPOSAL COMPANY RESERVES THE RIGHT TO REVISE GS PRICE IN
ACCORDANCE W ITTH ITS COSTS IN EFFECT AT SUCH TIME.
22.IF ANY PROVISION OF THIS AGREEMENT SHOULD BE HELD TO BE INVALID OR UNENFORCABLE,THE VALIDITY AND ENFORCEBILITY OF THE REMAINING PROVISIONS OF THIS AGREEMENT
SHALL NOT BE AFFECTED THEREBY.
23.ARBITRATION(IN THE EVENT THE CLIENT AND COMPANY HAVE A DISPUTE REGARDING ANY OP THE TERMS.CONDITIONS PROVISIONS,OR PERFORMANCE OF THIS AGREEMENT,THE PARTIES
AGREETO PLACE THE MAWER TNFOARBITPATION BEFORE AN INDEPENDENT ARBITRATOR ASS1GNEDBY THE AMERICAN ARBITRATION ASSOOATIONTO RESOLVETHEIR DISPUTE.
24.ANY DISCOUNT"PROMOTION,REIMBURSEMENT,CR OTHER PROGRAM THAT 15 PART OF A STATE SPONSERED LRKNY PROGRAM LLE.MASS SAVE)IS SUBJECT TO THE AVAIIARILTIV OF
QUALIFYING STATE SPONSERED PROGRAM AND WILL BE SUBJECT TO TERMINATION IF THE STATE SPONSERED UTILITY PROGRAM IS DISCCONTNUED.FURTHERMORE THE TERMS AND
CONDITIONS OF STATE SPONSERED UTILITY PROGRAMS MAY BE ALTERED OR UPDATED PERIODICALLY WITH OR WITHOUT NOTICE.
25.AMERICAN INSTALLERS,LLC IS NOT AN AGENT OF ANY UTILITY COMPANY OF OTHER VENDOR WORKING BY,THROUGH,OR UNDER THE MASS SAVE ENERGY PROGRAM.
26.CLIENT(5 REPSONSIBLE FOR THE PAYMENT OF ANY AND ALL FEDERAL,MATE,OR LOCAL TAXES THAT ARE APPLICABLE TO THIS AGREEMENT.
.tCk The Commonwealth of Massachusetts
....0••— Department of Industrial Accidents
>=. .,_hit
6lit ,: _;a Office of Investigations
A 600 Washington Street
Boston,MA 02111
www.nrass•.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractora/Eiectriciana/Plumbers
Applicant Infprmation Please Print Legibly
Name(Business/Orgmhatiodlndividual: American Installations,LLC
Address: I30 College Street,Suite 100
City/State/Zip: South Hadley,MA 01075 Phone #: 413-552-0200
Are you as employer?Check the appropriate box: Type of project(required):
1.0 tam a employer with 31 4. 0 I am a general contractor and i 5. ❑New construction
employees(full and/or part-time).* have hired the sub-contractors
2.❑ I am a sole proprietor or partner- listed on the attached sheet.t 7. ❑Remodeling
ship and have no employees These sub-contractors have 8. ❑Demolition
working for me in any capacity. workers'comp.insurance. 9. 0 Building addition
No workers'comp.insurance 5. 0 We area corporation and its
required.] officers have exercised their 10.0 Electrical repairs or additions
3_LJ I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions
myself. [No workers'comp. c. 152,§1(4),and we have no 12.[]Roof repairs
insurance required.]t employees.(No workers'
comp.insurance required.] 112 Other Insulation
"Any applicant that checks box#1 must also fill out the section below showing their workers compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then him outside wonders must submit a new affidavit indicating such.
;Contractors that check this box must anWchM An additional sheet showing arc name of the sube000ectws and their workers'camppolicy intoanation.
I am an employer that 15 providing workers'compensation insurance for my eemt gees. Below a the polity and job site
informa&on.
Insurance Company Name: Guard Insurance Companies
Policy#or Self-ins.�Lie,#: AM}WC731485 jam,,, Expiration Date: 04104/2017 � � f� ry r.t r�
lob Site Address: D r�(•le.&Jo ill 1��-+ City/State/Zip:,f\QrEACi2) 1w A Cl'Uag---
Attach a copy of the workers'compensation policy declaration page(showing the policy number and aspiration date).
Pailme to secure coverage as required under Section 25A of MOL c. 152 can lead to the imposition of criminal penalties of a
tine up to S 1,50000 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify under the pains and penalties of perjury that the hrformmlon provided above is true and correct
Sianaturt'. t/ eAt4 /9 (2,4a/Z01.9.-__ L_ Date: ' ‘Q—��
Phone 4: 413-552-0200
Official use only, Do not write in tha area,to be completed by city or town Okla
City City or Town: PermiULicense#„
Issuing Authority(circle one):
I.Hoard of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
ti-Other
Contact Person: Phone#:
A4Oa CERTIFICATE OF LIABILITY INSURANCE DATE0,1�Y01Y6YY)
NIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFRRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(SL AUTHORIZED
REPRESENTATIVE OR PRODUCER.AND THE CERTIFICATE HOLDER.
IMPORTANT: N the certificate holder Y an ADDITIONAL INSURED,the poiiy(Ies)must be endorsed. If SUBROGATION IS WAIVED,subject to
the terms and condwwTs of the policy.certain policies may require an endorsement A statement on this certificate does not corder rights to the
°enfioate holder in lieu of such endorsement(s).
PRODUCER QCT Linda Powers
Webber 6 Grinnell I, (413)586-0111 PAZ 1413)56'S4411
8 North Ring Street1powersewebberaodgrinnall.ccs
AIIJNrPAt PEURER(3)AFFORDING COVERAGE MRCP
Northeepton NA 01060 INSURERS Employers Mutual Casualty
INSURED
INSURER CBertehiN Hathaway, G�nlm Ins. Co.
American IneUilations, LLC INSURER
Attn: Wes 6 Susanne Couture INSURER!):
130 College Street, suits 100 INSURER E:
South Hadley tem 01075 SOURER F:
COVERAGES CERTIFICATE NUMBER54eeter sap 9-2017 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED pBY PAID CLAIMS.
JLm TYPE OF INSURANCE ,sj AMD, POLICY NUMBER INygryryYp IWm3'DINYYERYYI u_T3
COMMERCIAL GENERALT Scary
EACH OCCURRENCE 1,000,000
DAMAGE 10 RENTED
A X CWMSMADE OCCUR PREMISES[Fa wannCel 500,000
X Liquor Liability 15D3535217 9/4/2016 9/4/2017 MEDEXP May cos priOn) 10,000
PERSONAL&AIN Withal 1,000,000
GENL AGGREGATE UNIT APPLIES PER GENERAL AGGREGATE 2,000,000
A potICY ERCT LOG PRODUCTS-COMP/PAOG 2,000,000
ODER:
AUTOMOBILE IIARIUTY MJS NDDSINGLE gal 1,000,000
qa 41C910
A -MANY AUTO r EDGILY INJURY(Per pain)
ALL R SCHEDULED5e3535217 9/4/2016 9/4/2017 BODILY INJURY(Per modest,AUTOS
RO FE fHIRED AUTOS AUTOS
PIP-Base 8,000
X UMBRELLA LMB —I OCCUR EACH OCCURRENCE 1,000,000
A
"--
1 EXCESS LNB i CLAMS-MADE AGGREGATE 1,000,000
DEO X RETENTIONS 10,000 523535217 9/4/2016 9/4/2017
I WORKERS COMPENSATION a PER oTl-
IANOEMPLOYERS*W1BILITY YIN STATUTE FR
1ANY PR ETOWPAanaTFECUTNEEL EACH ACCIDENT __ 500,000
CFFICER/MEMIER EXCLUDED? NIA _I
B I WMNory In NM) j
rURNCS0991'7 9/4/2016 9/4/2017 EL DISEASE-EA EMPLOYER 500,000
yes.Snags
mee under
POJCY UNIT[ 500,000
I CFes SnOF OPERATIONS E L DISEASE
Commercial Property 5A3535217 9/4/2016 9/4/2017 1 meows$10x* 820,000
N.amMs+0o0 $40,000
DESCRIPTION OF OPENTKNS I LOCATIONS I VEHICLES (ACORD 101,masons Remarks Seem*may Ow<NM6 a mom Woe Y mIWM)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POUCES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTIORMEDREPRE.SEMATVE
Kevin Joyce/LMP '
0198&2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014/01) The ACORD name and logo are registered marks of AGGRO
1519025 nn,4nn
lirMassachusetts-Department of Public Safety Unrestricted-Buildings of any use group which
Board of Building Regulations and Standards contain less than 35,000 cubic feet(99Im)of
Construction Supervisor 1..� enclosed s-jrace.
License: CS-106178
tet ii‘ r.E
WESLEY COUTUJIE i^. 'p
NOR
Sou hHadS /.e
South Hadley h1M.tE6
Failure to possess a current edition of the Massachusetts
r-� �.rno s> State Building Codns
e is for revocation of this license.
Jam.J/ Expiration
Commissioner 68/28/2017 For DP5 Rreaina adermatmnvisR www.Mass.Gov/DP5
^ 4 r _ /. �J,J
L.J 122 'I L V/Z %(�GCL ,
,o' Office of Consumer Affairs and Busi- ss Reg-lation
I_ 10 Park Plaza- Suite 5170
Boston, Massachusetts 02116
Home Improvement Cogtraetor Registration
Registration: 175982
Type: LLC
Expiration 6/272017 Tat 265208
AMERICAN INSTALLATIONS, LLC.
WESLEY COUTURE
130 COLLEGE STREET SUITE 100
SOUTH HADLEY, MA 01075
Update Address and return card.Mark reason for change.
aCAI 0 20M-05m _ El Address I] Renewal 0 Employment U Lost Card
dune'F-IV/moan//a ofrA.marAuieh
Office of Consumer Affairs&Business Regulation License or registration valid for individul use only
'9 rY, OME IMPROVEMENT CONTRACTOR
before the expiration date. If found return to:
egistradon: 175982 Type: Office of Consumer Affairs and Business Regulation
'' Expiration: 6127201- LLC 10 Park Plaza-Suite 5170
Boston,MA 02116
AMERICAN INSTALLATIONS,LLC
WESLEY COUTURE i r / _
130 COLLEGE STREET SUITE 100 ., .E., -.1. ,„__
SOUTH HADLEY,MA 01 075 `- - / i _r
Undersecretary N valid without signature